Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00524
DEVELOPMENT SERVICES DATE ISSUED: 9/18/2006
` 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 103 BB - 07000
SITE ADDRESS: 12185 SW WALNUT ST ZONING: R - 4.5
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: (1) feeder, (5) branch circuits.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVCI FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: 5 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
RICHARD BOLEN OWNER
12185 SW WALNUT ST.
TIGARD, OR 97223
Phone: 503 - 579 - 8171 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 9/18/2006 $113.55
[TAX] 8% State Surcharge 9/18/2006 $9.08
Total $122.63 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of i an 4 - or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notif .tion C •nter. Those rules are set
forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct question- to OUN at 503 - 246 -6699 or
1- 800 - 332 -2344.
Issued By: / / Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Ir
Electrical Permit Application �: > " e'- > r i} ,
` �, 1OI tS. 1(1 Il c� " �i
"*" , City of Tigard Received 1S - ® , � Permit No. « D05 G C$ 7
i 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
1, Other Permit:
Z t ® , ,�.�•' t Phone: 503.639.4171 Fax: 503.598.1960 Date /By
rp�t1'.'z Inspection Line: 503.639.4175 Date Ready/By: luri El See Page 2 for
0 11 GSA R•O p
a15!'r.�3: a Internet: www.tigard or.gov Notified/Method: Supplemental Information
TYPE QF WORK PLAN REVIEW .
❑ New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY' OF CONSTRUCTIO exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ❑ Commercial /industrial ccessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB S ITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: `'Lk, O 4 6 ) J v1/4.1 iri N 1A 100HP or more. occupancy.
❑
❑ Six or more residential units. Recreational vehicle parks.
. City / State/ZIP: 'r; �A �L . q'7 Z y 3 ❑ Health -care facilities. ❑ Supply voltage for more than
i ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
q - FEE SCHEDULE . '
Cross street/directions to job site: l P ` 5 Description 1 Qty. 1 Fee. 1 Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
' DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
c w C _ , 5 4•(1-- J k 1 _l • Limi ever (, muaiove s ) 75.00 2
K� 1 /��► l C� �M � residential (with above ft. Services or wI 4 tAil. Q (,-✓\ 4 .l "' (Z) 1' LAM-TS • 00 amps or less feeders
es ders installation, alteration, 8 a 0.30 /or relocation 2
❑ PROPERTY OWNER I ❑ TENANT , 201 amps to 400 amps 106.85 7S 2
Name: a ■ LlAcc A I - Ti)v' Q .A 401 amps to 600 amps 160.60 2
C w 064, � ((\J1 601 amps to 1,000 amps 240.60 2
Address: ` Z \ / %- 7 L'__� 1\41L-- 51-, Over 1,000 amps or volts 454.65 2
City /State/ZIP: lVZ_ / - R") 7-v3 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (40 6 • 1 4 & 1 -7 1 Fax: ( ) 200 amps or less 66.85 1
Owner installation: This ins Nation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, ent, e change, according to ORS 447, 449, 670, and 7 1. 401 amps to 599 amps 133.75 2
r/ X / Branch circuits - new, a or extension, per panel
Owner signature: Date: /1 !� 6 0 A. Fee for branch circuits with
` VLAPPLICANT I . &ONTACT PERSON• above service or feeder fee, S 6.65 33 � 2
YYYYYY���� each branch circuit
Business name: B. Fee for branch circuits
Contact - A without service or feeder fee,
ontact name: 46.85 2
4 Ar CP 1d I.Q.,,� first branch circuit
Address: Z \ 1 -1,,L) v V (/,-Q N y` 5( • Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State/ZIP: 1--i' A C. • q) 2-z3 Each manufactured or modular 90.90 2
�• dwelling, service and/or feeder
Phone: (F ) V ' 711 Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR . Sign or outline lighting 53.40 2
Business name: Signal circuit(s) or limited -
energy panel, alteration, or
Address: " errAfrtA extension. Describe: Page 2 2
City /State/ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (I hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES • _' .
Suprv. Electrician signature, required: Sub / / ", 5,5
Print name: Date: Plan review (25% of permit fee):
State surcharge (8% of permit fee): /. 0
Authorized signature: TOTAL PERMIT FEE: / 3
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\ Building \Perrnits\ELC- PermitApp.doc 05 /23/06 440- 4615T(1I /05 /COM/WED
Electrical Permit Application - City of Tigard
Page 2- Supplemental Information
LIMITED ENERGY PERMIT FEES:
i RESIDENTIAL WORK ONLY:
•
Fee for all residential systems combined $75.00
Check Type of Work Involved:
El Audio and Stereo Systems* ,
El Burglar Alarm
El Garage Door Opener*
El . ,
Heating, Ventilation and Air Conditioning System*
El Vacuum Systems*
0 Other
r COMMERCIAL WORK ONLY:
Fee for each commercial $75.00 •
r.! , . ; • T •,. (.•
system
(SEE OAR 918-260-260)
Check Type of Work Involved: .
El Audio and Stereo Systems
1=1 Boiler Controls
D Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
D HVAC
Instrumentation
; . .
ID Intercom and Paging Systems
• •
- .
D Landscape Irrigation Control*
El Medical
CI Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
1=1 Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I U3tulding\l'ennits \ELC-PemutApp doc 03/23/06